| NPI | 1548221765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NJ MB037815) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NY 142456) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2007-07-08 |