| NPI | 1417227661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 59582) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT-198016-T) |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2017-01-31 |