| NPI | 1922461789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX T4977) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD474934) |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2023-09-26 |