| NPI | 1548217383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: IL 036167569) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME102585) |
| 208C00000X Colon & Rectal Surgery (Licence: FL ME102585) | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2024-01-23 |