NPI | 1912292186 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MB09864800) |
Additional Taxonomies | 208600000X Surgery (Licence: PA OT014247) |
Enumeration Date | 2011-06-15 |
Last Update Date | 2021-02-03 |