| NPI | 1053463885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2013-01757) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT183538) |
| 208600000X Surgery (Licence: PA MD429745) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2014-08-15 |