| NPI | 1770549917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA C147292) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA06782900) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2021-06-30 |