| NPI | 1013967884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME136929) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 057799) |
| 208600000X Surgery (Licence: PA MD450548) | |
| 208600000X Surgery (Licence: MA 223815) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2020-08-31 |