| NPI | 1336221399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA02271500) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME17429) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2011-05-03 |