| NPI | 1194980110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CO DR.0052467) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: CO 52467) |
| 208C00000X Colon & Rectal Surgery (Licence: NJ 25MA08915200) | |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2021-12-16 |