| NPI | 1417101502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NJ 25MA09346300) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA09346300) |
| Enumeration Date | 2008-11-16 |
| Last Update Date | 2021-03-24 |