| NPI | 1386701282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA06180800) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ ma61808) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2023-10-06 |