| NPI | 1477846046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X (Licence: NJ 25MA10936700) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 94-07612) |
| 2086S0129X (Licence: TX R4153) | |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2020-11-30 |