| NPI | 1750708780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME162710) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036144792) |
| 208600000X Surgery (Licence: NJ 25MA10886700) | |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2024-01-24 |