| NPI | 1902063589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 248217-1) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: OH 121521) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2014-05-27 |