| NPI | 1871602789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX T5124) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX T5124) |
| 208C00000X Colon & Rectal Surgery (Licence: NY 204067) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2025-07-08 |