| NPI | 1760482269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 29314) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.127073) |
| 208600000X Surgery (Licence: PA MD040420E) | |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2020-05-21 |