| NPI | 1730330861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MB08933000) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA os014239) |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2021-04-26 |