| NPI | 1124318332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA10126500) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD454192) |
| Enumeration Date | 2011-04-10 |
| Last Update Date | 2023-12-21 |