| NPI | 1912935057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD030268E) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D86334) |
| 208600000X Surgery (Licence: NC 39921) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: PA MD030268E) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2024-03-27 |