| NPI | 1720387319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA09005600) |
| Additional Taxonomies | 208600000X Surgery (Licence: NM MD2015-0456) |
| 208600000X Surgery (Licence: NC 2013-01981) | |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2018-07-17 |