| NPI | 1013054725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA05095200) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 40102) |
| 208600000X Surgery (Licence: GA GA040102) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2020-11-17 |