| NPI | 1134416860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 56655) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 313539) |
| 208600000X Surgery (Licence: NJ 25MA10824500) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2025-09-19 |