| NPI | 1871797019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TN MD43217) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT-182974) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2020-06-26 |