| NPI | 1720373855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA10525900) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2011016892) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2021-02-05 |