| NPI | 1184821266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 223145) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA09078900) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2018-08-23 |