| NPI | 1013321603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD469081) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT207214) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2020-07-13 |