NPI | 1437174026 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: NJ MA59823) |
Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA05982300) |
Enumeration Date | 2006-07-13 |
Last Update Date | 2021-11-11 |