| NPI | 1407194996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.136788) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT203088) |
| Enumeration Date | 2013-01-18 |
| Last Update Date | 2020-09-22 |