| NPI | 1215987417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D60748) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA08709400) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2013-12-08 |