| NPI | 1871158667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PR 23275) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA12190300) |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2025-05-24 |