| NPI | 1952740185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25ma09546800) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 270441) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2021-02-05 |