| NPI | 1689763179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: LA MD.15053R) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ MA067865) |
| 208C00000X Colon & Rectal Surgery (Licence: PA MD439694) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2015-05-04 |