| NPI | 1093780355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: PA MD042783E) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD042783E) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2007-07-08 |