| NPI | 1568690014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL OS16658) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA09329900) |
| 208C00000X Colon & Rectal Surgery (Licence: FL 16658) | |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2022-08-24 |