| NPI | 1396090510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MB10627400) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OT014499) |
| Enumeration Date | 2012-07-14 |
| Last Update Date | 2020-10-19 |