| NPI | 1467517599 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NJ 25MA04470100) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA04470100) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2009-11-17 |