| NPI | 1902807282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: PA MD048367L) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD048367L) |
| 208600000X Surgery (Licence: NJ 25MA06215200) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2022-01-13 |