| NPI | 1447217492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: PA MD071492L) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD071492L) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: WV 28014) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2022-02-10 |