| NPI | 1265407514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: NJ 25MA07109100) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA07109100) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2010-11-16 |