| NPI | 1285650655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NJ 25MA08123400) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 245342) |
| 208C00000X Colon & Rectal Surgery (Licence: NY 245342) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2009-01-30 |