| NPI | 1962476663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X (Licence: NJ 25MA06390700) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA06390700) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2024-04-09 |