| NPI | 1023032752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA10201600) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA D0044007) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2024-05-16 |