| NPI | 1992984140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NY 279592) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 279592) |
| 208600000X Surgery (Licence: MN 57906) | |
| 208600000X Surgery (Licence: OH 57013951) | |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2022-05-11 |