| NPI | 1861985293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 22MB11934800) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA R-11303) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2024-05-30 |