| NPI | 1518112515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 54703) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA MD41639) |
| 208600000X Surgery (Licence: DC MD036678) | |
| 208600000X Surgery (Licence: VA 0116017922) | |
| Enumeration Date | 2008-11-19 |
| Last Update Date | 2022-07-21 |