| NPI | 1457359150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 175017) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 53480) |
| 208600000X Surgery (Licence: PA MD043048E) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2021-04-09 |