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 |