| NPI | 1437342987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MT-184-844) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 069282) |
| Enumeration Date | 2007-08-18 |
| Last Update Date | 2014-04-11 |