| NPI | 1528321502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA OS016711) |
| Additional Taxonomies | 208600000X Surgery (Licence: MS 33935) |
| 208600000X Surgery (Licence: PA OT014861) | |
| Enumeration Date | 2012-06-24 |
| Last Update Date | 2025-02-24 |