| NPI | 1649488693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD444038) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301088669) |
| 208D00000X General Practice (Licence: PA MD444038) | |
| 208600000X Surgery (Licence: NC 200901550) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2013-04-23 |