| NPI | 1659565067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25ma08395500) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35090423) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2009-05-28 |