| NPI | 1073509287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 25311) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.129621) |
| 208600000X Surgery (Licence: PA MD065086L) | |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2023-10-25 |