| NPI | 1124477617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD473878) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD61278049) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2022-09-02 |