| NPI | 1649484056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME108176) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT189542) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2022-07-21 |