| NPI | 1023286945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME163458) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD446487) |
| 208600000X Surgery (Licence: AL MD.42785) | |
| 208600000X Surgery (Licence: CA A102298) | |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2023-11-28 |