| NPI | 1013122464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD437043) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101260733) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2021-09-13 |