| NPI | 1275748659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME105330) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD427760) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2018-08-09 |