| NPI | 1790070605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD458697) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301098825) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2016-07-20 |