| NPI | 1710986682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD428316) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 200300950) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2009-09-16 |