| NPI | 1912961962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MO 2012016544) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NY 228452) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2020-11-18 |