| NPI | 1215958715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 9501257) |
| Additional Taxonomies | 2086S0129X (Licence: PA MD434078) |
| 2086S0129X (Licence: ID 8971137) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2026-09-28 |