| NPI | 1831114511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0038764) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD042103L) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2018-04-24 |