| NPI | 1962906669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: IL 036168379) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036.168379) |
| 208600000X Surgery (Licence: NJ 25MA11358100) | |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2026-06-15 |