| NPI | 1467426031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD058502L) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 192712-1) |
| 208C00000X Colon & Rectal Surgery (Licence: PA MD058502L) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2021-03-08 |