| NPI | 1467464479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MB08248700) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OS013718) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2021-06-04 |