| NPI | 1285665034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD051108L) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA06791900) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2022-02-17 |