| NPI | 1700509452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NY 318235) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 318235-01) |
| Enumeration Date | 2022-09-19 |
| Last Update Date | 2022-11-01 |