| NPI | 1700840923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD068495L) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2009-00124) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2025-04-02 |