| NPI | 1982851119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CT 76310) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NY 259014) |
| 208C00000X Colon & Rectal Surgery (Licence: FL ME128201) | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2025-09-10 |