| NPI | 1932296217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD447901) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60284253) |
| 208600000X Surgery (Licence: NY 277054-1) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2015-03-26 |