| NPI | 1134353592 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NJ 25MA11369600)  | 
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NY 241908-1)  | 
| Enumeration Date | 2009-05-13 | 
| Last Update Date | 2022-07-28 |