| NPI | 1932524758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MB12009900) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OS019110) |
| Enumeration Date | 2014-03-03 |
| Last Update Date | 2024-02-02 |