| NPI | 1356668602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: PA MD465325) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NJ 25MA10087200) |
| 208C00000X Colon & Rectal Surgery (Licence: NY 264347) | |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2018-12-03 |