| NPI | 1881858512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD440199) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC TEMPARARY) |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2020-08-06 |