| NPI | 1558362970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: TN 69307) |
| Additional Taxonomies | 2086S0129X (Licence: MS 32614) |
| 208600000X Surgery (Licence: NJ MD418452) | |
| 2086S0129X (Licence: PA MD418452) | |
| 2086S0129X (Licence: AR E-17594) | |
| 2086S0129X (Licence: SC 36405) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2025-01-23 |