| NPI | 1285821322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.099078) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT 188179) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2012-08-09 |