| NPI | 1881645364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 56511) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA09589800) |
| 208600000X Surgery (Licence: NY 232366) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2025-09-11 |