| NPI | 1750727665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MT204216) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD460975) |
| Enumeration Date | 2013-05-18 |
| Last Update Date | 2018-08-05 |