| NPI | 1134416860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 56655) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA10824500) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2021-12-22 |