| NPI | 1104146323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MB09901200) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OS015927) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2022-06-10 |