| NPI | 1285671925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NY 225041) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 210386) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2021-05-20 |