| NPI | 1225460231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 20A 10731) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 01280) |
| 208600000X Surgery (Licence: NJ 25MB05799800) | |
| Enumeration Date | 2013-07-31 |
| Last Update Date | 2013-07-31 |