| NPI | 1528079290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD038887L) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ MA03803900) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2020-09-21 |