| NPI | 1184286957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery (Licence: CA 1467795161) |
| Additional Taxonomies | 261QU0200X Clinic/Center Urgent Care (Licence: ID PA-2091) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2022-05-05 |