| NPI | 1649245358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: SC 38560) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA06665400) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2016-06-10 |