| NPI | 1649236423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA C190984) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD066823L) |
| 208600000X Surgery (Licence: TN 38725) | |
| 208600000X Surgery (Licence: NJ 25MA07587100) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2023-10-23 |