| NPI | 1568880862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NJ 25MA10863500) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 306123) |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2025-02-04 |