| NPI | 1194754564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101239990) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD441529) |
| 208600000X Surgery (Licence: NC 2009-00497) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2017-02-22 |