| NPI | 1104313196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MB11851800) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NJ 25MB11851800) |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2025-08-23 |