| NPI | 1033397666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD459133) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 285278) |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2025-02-06 |