| NPI | 1942484159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME141952) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 267289) |
| 208600000X Surgery (Licence: NJ 25MA09944300) | |
| 208C00000X Colon & Rectal Surgery (Licence: NJ 25MA09944300) | |
| 208C00000X Colon & Rectal Surgery (Licence: NY 267289) | |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2019-12-16 |