| NPI | 1821331141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD480990) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101264260) |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2023-08-01 |