| NPI | 1992933386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 258413) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA09690300) |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2022-07-21 |