| NPI | 1063627347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 247175) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 044519) |
| 208600000X Surgery (Licence: NJ 25MA08845600) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2014-04-30 |