| NPI | 1902881444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: PA MD489111) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NY 162606) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2025-04-15 |