| NPI | 1306228937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD470278) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT209546) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2024-01-22 |