| NPI | 1083685598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2015-02396) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD-041396-E) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2020-10-09 |