| NPI | 1356517098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD29150) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT184175) |
| Enumeration Date | 2008-05-02 |
| Last Update Date | 2013-10-25 |