| NPI | 1366447203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA06857900) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI MD11579) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2025-08-27 |