| NPI | 1750551347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: PA MD436987) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA07891700) |
| 208C00000X Colon & Rectal Surgery (Licence: IL 036120744) | |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2026-02-02 |