| NPI | 1730526070 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NJ 25MA10659100) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA10659100) |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2019-10-02 |