| NPI | 1861647463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 2559201) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD439948) |
| 208C00000X Colon & Rectal Surgery (Licence: PA MD439948) | |
| Enumeration Date | 2008-11-24 |
| Last Update Date | 2016-02-22 |