| NPI | 1386818060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301095232) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD434232) |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2026-03-20 |