| NPI | 1215247515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD471893) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA10411400) |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2020-10-08 |