| NPI | 1508021007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD448480) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 90522) |
| 208600000X Surgery (Licence: MS 21411) | |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2022-01-26 |