| NPI | 1578551610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2025-00738) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD447277) |
| 208600000X Surgery (Licence: MA 76110) | |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2025-08-13 |