| NPI | 1437264322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD471575) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID M15179) |
| 208600000X Surgery (Licence: WA MD00047066) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2022-10-11 |