| NPI | 1003062050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2008-01198) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA08777400) |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2025-06-05 |