| NPI | 1619132214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 264608) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NY 264608) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2016-11-02 |