| NPI | 1679572739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MB07801000) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 232242) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2009-09-25 |