| NPI | 1194043406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 88970) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 282749) |
| 208600000X Surgery (Licence: NY TO BE ISSUED) | |
| 208600000X Surgery (Licence: NJ 25MA11481000) | |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2023-02-01 |