| NPI | 1558330621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: PA MD435011) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NY 221421) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2016-11-22 |