| NPI | 1790819084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA11096900) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 228177) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2021-09-20 |