| NPI | 1003090911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD438913) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2006-01310) |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2010-03-18 |