| NPI | 1023042132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 1552161) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA04605900) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2013-01-25 |