| NPI | 1841281995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: PA MD433750) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2005-01072) |
| 208600000X Surgery (Licence: NJ 25MA08649700) | |
| 208C00000X Colon & Rectal Surgery (Licence: NJ MA08649700) | |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2012-12-14 |