| NPI | 1366539769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA09424600) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 207798) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2014-05-02 |