| NPI | 1508120882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA11620200) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 92894) |
| Enumeration Date | 2012-07-01 |
| Last Update Date | 2025-03-11 |