| NPI | 1609897198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA04424200) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD024812E) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2007-07-08 |