| NPI | 1952535403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 266646) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA09800800) |
| Enumeration Date | 2009-05-13 |
| Last Update Date | 2016-03-25 |