| NPI | 1467795195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101275680) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD468394) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2023-02-24 |