| NPI | 1043660608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 14185553-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT211652) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2026-04-10 |