| NPI | 1093035461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: DC MD210001833) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA L-244073) |
| 2086S0129X (Licence: VA 0101257909) | |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2024-07-10 |