| NPI | 1700926078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: PA MD468500) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 293639) |
| 208C00000X Colon & Rectal Surgery (Licence: KY 35071) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2021-09-17 |