| NPI | 1972555621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2008-01460) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY MD40649) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2020-10-28 |