| NPI | 1811908924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MB06195300) |
| Additional Taxonomies | 208600000X Surgery (Licence: DE C20006928) |
| 208600000X Surgery (Licence: PA OS007439L) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2023-07-14 |