| NPI | 1639339542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD432903) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT185755) |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2021-01-09 |