| NPI | 1457350159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: DE C10006581) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD432554) |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2022-02-04 |