| NPI | 1508962549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD017139E) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA02395700) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2009-07-02 |