| NPI | 1003075755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA08979400) |
| Additional Taxonomies | 208600000X Surgery (Licence: DE C1-0027264) |
| Enumeration Date | 2008-06-07 |
| Last Update Date | 2024-09-05 |