| NPI | 1720398001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME130870) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 38992) |
| 208600000X Surgery (Licence: PA mt198230) | |
| 208600000X Surgery (Licence: PA MD454183) | |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2021-11-22 |