| NPI | 1841290517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA07710100) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 217173) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2012-09-28 |