| NPI | 1922104603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2013-01788) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD034113E) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2016-10-04 |