| NPI | 1700926078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: SC 95183) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: KY 35071) |
| 208600000X Surgery (Licence: NY 293639) | |
| 208C00000X Colon & Rectal Surgery (Licence: PA MD468500) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2025-08-21 |