| NPI | 1285707554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ MA46485) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MA043030E) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2018-02-01 |