| NPI | 1770782369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX P0106) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA08762800) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2026-02-04 |