| NPI | 1356662688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101273454) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD448329) |
| 208600000X Surgery (Licence: PA MT198228) | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2023-10-31 |