| NPI | 1619949799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD026375E) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD026375E) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2007-12-06 |