| NPI | 1750526158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35122805) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA07692200) |
| 208C00000X Colon & Rectal Surgery (Licence: MD D0070668) | |
| Enumeration Date | 2008-12-14 |
| Last Update Date | 2014-05-07 |