| NPI | 1861874414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: PA MD470600) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD470600) |
| 208600000X Surgery (Licence: PA MT209752) | |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2022-02-01 |