| NPI | 1609840628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD424620) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD424620) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2011-04-12 |