| NPI | 1437333630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2018-02219) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD449620) |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2019-01-17 |