| NPI | 1104932045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME163249) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME 108504) |
| 208600000X Surgery (Licence: AZ 45917) | |
| 208600000X Surgery (Licence: PA MD435576) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2023-07-03 |