| NPI | 1598906802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 31763) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD461041) |
| 208600000X Surgery (Licence: MI 4301503608) | |
| Enumeration Date | 2009-03-16 |
| Last Update Date | 2026-05-22 |