| NPI | 1396008389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX R4575) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25mb10090300) |
| Enumeration Date | 2012-06-24 |
| Last Update Date | 2021-03-03 |