| NPI | 1285165738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD486007) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: PA MD486007) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2025-08-13 |