| NPI | 1881004745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25ma11343300) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01081217A) |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2024-05-23 |