| NPI | 1770966053 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2021028479) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD470615) |
| Enumeration Date | 2015-07-03 |
| Last Update Date | 2021-10-14 |