| NPI | 1598146441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD488099) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN23030) |
| 208D00000X General Practice (Licence: MA 281577) | |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2025-07-11 |