| NPI | 1770525156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD429457) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A52489) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2012-03-27 |