| NPI | 1629573555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NV LL3253) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 000000000000) |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2019-07-24 |