| NPI | 1427115823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2012-00109) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT187077) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2012-12-06 |