| NPI | 1528274842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NV 19452) |
| Additional Taxonomies | 208600000X Surgery (Licence: MT MED-PHYS-LIC-51952) |
| 208600000X Surgery (Licence: PA MT188337) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2023-08-07 |