| NPI | 1447218557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: PA OS005245L) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NJ 25MB04161500) |
| 208C00000X Colon & Rectal Surgery (Licence: FL OS8396) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2007-07-08 |