| NPI | 1417186859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: WI 65773) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ MA08835400) |
| 208600000X Surgery (Licence: WI 65773) | |
| 208C00000X Colon & Rectal Surgery (Licence: NJ 25MA08835400) | |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2016-06-29 |