| NPI | 1902064140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA08543800) |
| Additional Taxonomies | 208600000X Surgery (Licence: DE C1-0011498) |
| 208600000X Surgery (Licence: MD D0067469) | |
| Enumeration Date | 2008-05-23 |
| Last Update Date | 2025-07-09 |