| 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 |