| NPI | 1851619084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25ma10146000) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D81509) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2019-11-07 |