| NPI | 1225045057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 137389) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NY NY137389) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2023-03-07 |