| NPI | 1215059399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NJ 25MA08254600) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NY 241774) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2019-01-25 |