| NPI | 1962659912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA09124500) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 251092) |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2013-05-30 |