| NPI | 1417047648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 194532) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MB06674000) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2026-07-15 |