| NPI | 1407046824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 005651) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MB08495000) |
| 208600000X Surgery (Licence: PA OS014837) | |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2025-01-05 |