| NPI | 1972501856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD010352E) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD010352E) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2014-02-10 |