| NPI | 1013295195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2016-00883) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OT014098) |
| Enumeration Date | 2011-07-24 |
| Last Update Date | 2016-10-05 |