| NPI | 1417093675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: ME DO4019) |
| Additional Taxonomies | 208600000X Surgery (Licence: NH 34438) |
| 208600000X Surgery (Licence: MA 222680) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2026-01-28 |