| NPI | 1578999116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NJ 25MA03586200) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA03586200) |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: NJ 25MA03586200) | |
| Enumeration Date | 2013-09-14 |
| Last Update Date | 2013-09-14 |