| NPI | 1811154610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD439548) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101251305) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2020-11-12 |