| NPI | 1255310660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD011980E) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: NC 2013-0235) |
| 208600000X Surgery (Licence: MN 40674) | |
| 208600000X Surgery (Licence: NC 2013-0235) | |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2018-03-28 |