| NPI | 1033415732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X (Licence: PA MD443921) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT-194653) |
| 208600000X Surgery (Licence: PA MD443921) | |
| Enumeration Date | 2011-01-28 |
| Last Update Date | 2019-04-22 |