| NPI | 1144481383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2024-02901) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 35614) |
| 208600000X Surgery (Licence: PA MT192606) | |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2025-07-10 |