| NPI | 1659397297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: NJ 25MA03497900) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA03497900) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2008-05-01 |