| NPI | 1548651136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD481294) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA11913800) |
| Enumeration Date | 2015-02-18 |
| Last Update Date | 2023-09-17 |