| NPI | 1225220320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 340280) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY TP279) |
| 208600000X Surgery (Licence: KY 59883) | |
| 208600000X Surgery (Licence: TX P0497) | |
| 208600000X Surgery (Licence: PA MD427801) | |
| 208600000X Surgery (Licence: OH 35099820) | |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2025-11-19 |