| NPI | 1083939433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA10122100) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 284459) |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2023-07-31 |