| NPI | 1982634978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD070524L) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NJ 25MA0824200) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2021-04-12 |