| NPI | 1528229622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101254104) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT193203) |
| 208600000X Surgery (Licence: NC 2015-02293) | |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2017-11-22 |