| NPI | 1568774222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA09943400) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A152534) |
| 208600000X Surgery (Licence: NY 290405) | |
| Enumeration Date | 2010-07-10 |
| Last Update Date | 2024-06-04 |