| NPI | 1972983625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME150802) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA10697000) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2021-07-29 |