| NPI | 1497910228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD442394) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA Mt189355) |
| 208600000X Surgery (Licence: NY 269090) | |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2021-04-02 |