| NPI | 1184655482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 19442) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA md060675L) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2022-04-05 |