| NPI | 1194075903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: KY R3376) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT202295) |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2014-07-15 |