| NPI | 1184831406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MB08739300) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 60-243324) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2019-03-07 |