| NPI | 1619962743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: PA MD054801L) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101028578) |
| 208600000X Surgery (Licence: NJ 25MA08122200) | |
| 208600000X Surgery (Licence: PA MD054801L) | |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2013-08-04 |