| NPI | 1871750984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NY 314890) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: TX Q5845) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2022-04-01 |