| NPI | 1841343514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60109911) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT179602) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2017-03-01 |