| NPI | 1114925005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD037959E) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA09025700) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2012-11-29 |