| NPI | 1306884507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301095540) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.141071) |
| 208600000X Surgery (Licence: NJ 25MA05624100) | |
| 208600000X Surgery (Licence: FL ME68246) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2021-12-24 |