| NPI | 1568697985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 340037) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD451901) |
| 208600000X Surgery (Licence: DE C1-0012386) | |
| Enumeration Date | 2009-05-29 |
| Last Update Date | 2025-11-25 |