| NPI | 1447639943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD481926) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI LP03494) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2023-10-11 |