| NPI | 1649432097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA09575100) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 270952) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2021-05-17 |