| NPI | 1528099017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MT 12350) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2005-00956) |
| 208600000X Surgery (Licence: PA MD421084) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2023-11-27 |