| NPI | 1871724617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NJ 25MB09855100) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY AP0771229-851) |
| Enumeration Date | 2009-07-28 |
| Last Update Date | 2021-12-21 |