| NPI | 1467444877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME125287) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35-084596) |
| 208600000X Surgery (Licence: PA MD437268) | |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2021-02-04 |