| NPI | 1518967249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA05569400) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA05569400) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2024-12-12 |