| NPI | 1730486184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD429666) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA08944300) |
| Enumeration Date | 2011-02-22 |
| Last Update Date | 2019-02-07 |