NPI | 1497289342 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: NY 336278-01) |
Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA11703000) |
Enumeration Date | 2017-04-18 |
Last Update Date | 2025-08-27 |