| NPI | 1548624877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: NJ 25MA12786300) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT210656) |
| 2086S0129X (Licence: PA MD467241) | |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2025-08-18 |