| NPI | 1255501375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA08187800) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 235162) |
| 208600000X Surgery (Licence: NJ 25NA08187800) | |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2023-04-03 |