| NPI | 1710334628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: NY 333115) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD465277) |
| 2086S0129X (Licence: PA MD465277) | |
| 208600000X Surgery (Licence: NY 333115) | |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2026-04-23 |