| NPI | 1841518776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD464754) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA10947200) |
| Enumeration Date | 2010-05-17 |
| Last Update Date | 2025-11-13 |