| NPI | 1952644718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301503153) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD465222) |
| Enumeration Date | 2013-03-30 |
| Last Update Date | 2025-09-09 |