| NPI | 1346506607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: IL 036.146496) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036146496) |
| 208600000X Surgery (Licence: NJ None) | |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2021-01-05 |