| NPI | 1679556757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME74612) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ MA05921000) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2018-04-24 |