| NPI | 1114177433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME166666) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD435362) |
| 208600000X Surgery (Licence: CA A119795) | |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2024-05-31 |