| NPI | 1306979208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA C168048) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA07918500) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2021-11-10 |