| NPI | 1104875400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NJ 25MA04250400) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA04250400) |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2025-10-27 |