| NPI | 1245424506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL Me107293) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA09461900) |
| 208600000X Surgery (Licence: NY 262892) | |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2024-10-21 |