| NPI | 1699074294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD438055) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: PA MD438055) |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2021-05-25 |