| NPI | 1649340555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: DC MD047707) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.085913) |
| 208C00000X Colon & Rectal Surgery (Licence: OH 35.085913) | |
| 208C00000X Colon & Rectal Surgery (Licence: FL ME159884) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2023-01-03 |