| NPI | 1235419060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME157236) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R72857) |
| 208600000X Surgery (Licence: NY P05877) | |
| 208600000X Surgery (Licence: WY 11435A) | |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2022-12-09 |