| NPI | 1104117092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA08889500) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD449191) |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2022-12-05 |