| NPI | 1942639091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CO DR.0061282) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: PA MD450149) |
| Enumeration Date | 2013-11-08 |
| Last Update Date | 2024-02-06 |