| NPI | 1477870368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 284981-1) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT196713) |
| Enumeration Date | 2010-04-30 |
| Last Update Date | 2019-06-04 |