| NPI | 1861992513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MB12229800) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 318368) |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2024-06-04 |