| NPI | 1679877583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD459591) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301105929) |
| Enumeration Date | 2011-01-06 |
| Last Update Date | 2022-07-21 |