| NPI | 1306233432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 296146) |
| Additional Taxonomies | 208600000X Surgery (Licence: DE C1-0028614) |
| 208C00000X Colon & Rectal Surgery (Licence: DE C1-0028614) | |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2025-10-08 |