| NPI | 1386661155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD052860L) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD052860L) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2023-11-06 |