| NPI | 1538455399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: KY 51366) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT199190) |
| 2086S0129X (Licence: OH 128605) | |
| 208600000X Surgery (Licence: PA MD453795) | |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2024-01-19 |