| NPI | 1063775864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA10898800) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME139217) |
| 208600000X Surgery (Licence: PA MT201578) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2020-09-30 |