| NPI | 1780883371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: PA MD419070) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ MA08224200) |
| 2086S0129X (Licence: NJ MA08224200) | |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2013-02-12 |