| NPI | 1437269016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA02267800) |
| Additional Taxonomies | 2086S0129X (Licence: NJ 25MA02267800) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2014-01-17 |