| NPI | 1548377096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 145388) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA06721400) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2019-05-10 |