| NPI | 1275932766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA10211600) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD467059) |
| 208600000X Surgery (Licence: NJ K44864297106862) | |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2021-06-23 |