| NPI | 1982640207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA09253500) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 040290) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2017-11-15 |