| NPI | 1710960752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD050115L) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: PA MD050115L) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2016-02-23 |