| NPI | 1679704761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MB09389500) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OS016794) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2016-03-16 |