| NPI | 1386866853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036.148925) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101250146) |
| 208C00000X Colon & Rectal Surgery (Licence: VA 0101250146) | |
| 208C00000X Colon & Rectal Surgery (Licence: PA MD461609) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2022-09-26 |