| NPI | 1164800850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA11518300) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT208732) |
| 208600000X Surgery (Licence: CT 68994) | |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2022-11-23 |