| NPI | 1831345461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA09873700) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125055235) |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2023-03-07 |