| NPI | 1255336590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD057901L) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD057901-L) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2009-10-07 |