| NPI | 1275646838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME149426) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME149426) |
| 208600000X Surgery (Licence: NY 235531) | |
| 208C00000X Colon & Rectal Surgery (Licence: NY 235531) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2021-09-01 |