| NPI | 1063432680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA10014800) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 233552) |
| 208600000X Surgery (Licence: GA 055362) | |
| 208600000X Surgery (Licence: NH 13284) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2017-08-24 |