| NPI | 1184927774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 92280) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT197299) |
| 208600000X Surgery (Licence: MA 261361) | |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2024-08-19 |