| NPI | 1770682643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD036027E) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101253604) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2014-08-13 |