| NPI | 1427206465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101261568) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57014130) |
| 208600000X Surgery (Licence: PA MD437033) | |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2016-12-12 |