| NPI | 1528038130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: NJ 25MB07722600) |
| Additional Taxonomies | 2086S0129X (Licence: NJ MB07722600) |
| 2086S0129X (Licence: PA OS025507) | |
| 208600000X Surgery (Licence: NJ MB07722600) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2026-03-05 |