| NPI | 1245689298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PR 22078) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA11014000) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2022-08-26 |