| NPI | 1952755639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MT214346) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD474161) |
| 208600000X Surgery (Licence: KY 56409) | |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2022-05-10 |