| NPI | 1518184464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MI 4301089402) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 003070) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2021-05-30 |