| NPI | 1568459477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0101863) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2008-01864) |
| 208600000X Surgery (Licence: PA MD07185L) | |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2026-04-10 |