| NPI | 1750488631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: PA MD436442) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD436442) |
| 2086S0129X (Licence: NY 195804) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2011-08-23 |