| NPI | 1548360530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ MA08549200) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD046539L) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2019-09-24 |