| NPI | 1821076548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 23871) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD042636L) |
| 174400000X Specialist (Licence: NJ 25MA06618600) | |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2026-07-27 |