| NPI | 1730258294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: VA 0101262770) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA06952500) |
| 208C00000X Colon & Rectal Surgery (Licence: NJ 25MA06952500) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2021-02-07 |