| NPI | 1356661839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D93042) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.137045) |
| 208600000X Surgery (Licence: PA MD458258) | |
| 208600000X Surgery (Licence: CA A148790) | |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2023-06-14 |