| NPI | 1568632263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD438853) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA08702900) |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2018-11-29 |