| NPI | 1699897538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME116185) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD431494) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2016-11-04 |