| NPI | 1023213204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: PA MD452136) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD452136) |
| 2086S0129X (Licence: NJ 25MA09082900) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2025-11-10 |