| 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 |