| NPI | 1033643994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA12758600) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 330313) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2025-08-15 |