| NPI | 1518192343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MT195184) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL TRN15996) |
| Enumeration Date | 2009-05-22 |
| Last Update Date | 2015-07-20 |