| NPI | 1700860657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 156627-01) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD027695E) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2021-11-04 |