| NPI | 1891986717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD433929) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 284072) |
| 208600000X Surgery (Licence: NC 2009-00997) | |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2021-03-29 |