| NPI | 1720012966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD032195E) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 340843) |
| 208600000X Surgery (Licence: MD D38627) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2026-01-23 |