| NPI | 1588809172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 253326) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA08465800) |
| Enumeration Date | 2008-12-10 |
| Last Update Date | 2011-08-30 |