| NPI | 1497795777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 236937) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA08079000) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2010-02-25 |