| NPI | 1720168503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: DC MD034387) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D0067585) |
| 208600000X Surgery (Licence: NY 243093) | |
| 208600000X Surgery (Licence: OH 35.084852) | |
| 208600000X Surgery (Licence: NC 2016-01879) | |
| 208600000X Surgery (Licence: VA 0101262598) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2021-11-30 |