| NPI | 1619984242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD040987E) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101250542) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2023-11-16 |