| NPI | 1356530539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA09666400) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 246562) |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2025-03-26 |