| NPI | 1336138213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 192158) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME87438) |
| 208600000X Surgery (Licence: CA G86707) | |
| 208C00000X Colon & Rectal Surgery (Licence: NY 192158) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2023-07-28 |