| NPI | 1710203914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA09700800) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 55233) |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2024-04-12 |