| NPI | 1679967913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NY 325261-01) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 325261-01) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2024-05-24 |