| NPI | 1639598436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 60612) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA10591900) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2020-04-21 |