| NPI | 1457515082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NY 306837) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.025170) |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2023-03-28 |