| NPI | 1255564787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 295046) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MB09572100) |
| 208600000X Surgery (Licence: GA 80784) | |
| 208600000X Surgery (Licence: PA OS018443) | |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2020-10-01 |