| NPI | 1679573307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ 25MA07605700) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA07605700) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2024-04-30 |