| NPI | 1215903844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD066677L) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 212422-1) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2019-03-26 |