| NPI | 1801058169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME126414) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD454268) |
| 208600000X Surgery (Licence: OH 35.122372) | |
| 208600000X Surgery (Licence: SC LL30950) | |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2021-08-27 |