| NPI | 1801897319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NJ 25MA47984000) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA47984000) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2018-08-16 |