| NPI | 1740481407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: PA MD462483) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NJ MA86703) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2022-08-09 |