| NPI | 1538297270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: PA MD438866) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC MD036495) |
| 208C00000X Colon & Rectal Surgery (Licence: NJ 25MA07859100) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2022-08-26 |