| NPI | 1659690196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX N7041) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX N7041) |
| 208600000X Surgery (Licence: PA MD438496) | |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2026-06-26 |