| NPI | 1336102227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MT 102083) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036-093519) |
| 208600000X Surgery (Licence: WV 29974) | |
| 208C00000X Colon & Rectal Surgery (Licence: KY 46444) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2022-11-15 |