| NPI | 1053317636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X (Licence: NJ 25MA02742400) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA02742400) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2024-03-13 |