| NPI | 1134387061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD434539) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT186210) |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2017-04-21 |