| NPI | 1730383498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0073377) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC MD035602) |
| 208600000X Surgery (Licence: PA MD433352) | |
| 208600000X Surgery (Licence: FL ME98540) | |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2021-09-16 |