| NPI | 1093197741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2020-02318) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT209619) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2021-12-01 |