| NPI | 1457424541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NY 238910) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 238910) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: NY 238910) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2022-03-28 |