| NPI | 1164622031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204F00000X Transplant Surgery (Licence: PA MD461713) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI LP01122) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2024-11-06 |