| NPI | 1386752012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA05603100) |
| Additional Taxonomies | 2086S0129X (Licence: NJ 25MA05603100) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2010-06-25 |