| NPI | 1427158831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NJ 25MA07131100) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA07131100) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2022-11-16 |