| NPI | 1386034072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 290287) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA11292900) |
| Enumeration Date | 2015-02-02 |
| Last Update Date | 2025-10-20 |