| NPI | 1538368428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA09741000) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10029983) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2016-03-15 |