| NPI | 1578825055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 87668) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT201891) |
| 208600000X Surgery (Licence: MI 4301502766) | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2022-10-11 |