| NPI | 1689893430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 25528) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD442164) |
| 208600000X Surgery (Licence: RI LP00408) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2022-07-21 |