| NPI | 1033648720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD481042) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: PA MD481042) |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2024-09-23 |