| NPI | 1770585655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME147949) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD070484L) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2021-06-11 |