| NPI | 1629398292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 76564) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD446097) |
| 208600000X Surgery (Licence: OH 35.134704) | |
| 208600000X Surgery (Licence: PA MT197232) | |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2022-03-02 |