| NPI | 1366408254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD422392) |
| Additional Taxonomies | 208600000X Surgery (Licence: NM MD2005-0150) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2021-03-19 |