| NPI | 1730308099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA02399500) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ MAO 23995) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2017-01-26 |