| NPI | 1073560397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA07323800) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 238435) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2011-09-21 |