| NPI | 1932350287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA09746200) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD446454) |
| Enumeration Date | 2008-10-06 |
| Last Update Date | 2021-04-13 |