| NPI | 1831360965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA10853800) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 247883) |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2020-06-23 |