| NPI | 1326329905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.150196) |
| Additional Taxonomies | 208600000X Surgery (Licence: IN 01093061A) |
| 208600000X Surgery (Licence: NY 2965791) | |
| 208600000X Surgery (Licence: PA MT199425) | |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2024-06-14 |