| NPI | 1528061355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD418609) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD418609) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2020-06-19 |