| NPI | 1083814933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD430870) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2009-04-28 |