| NPI | 1255394177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA10538700) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME152013) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2024-10-16 |