| NPI | 1619948536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NJ 25MA024994100) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA02494100) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2024-04-11 |