| NPI | 1295933620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2007-00608) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD431200) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2008-06-11 |