| NPI | 1144218181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD420494) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC MD32985) |
| 208600000X Surgery (Licence: NJ 25MA07422400) | |
| 208600000X Surgery (Licence: KS 04-33691) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2023-08-29 |