| NPI | 1952665465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MT202429) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA10374300) |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2020-10-05 |