| NPI | 1710973870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35064482) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 18107) |
| 208600000X Surgery (Licence: PA MD048163L) | |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2016-04-27 |