| NPI | 1134195381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD027818E) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 153726) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2011-04-13 |