| NPI | 1831163104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101056143) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA08036200) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2007-07-08 |