| NPI | 1093917221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: PA MD459118) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: KY 46080) |
| 208600000X Surgery (Licence: PA MD459118) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2025-12-29 |