| NPI | 1568663425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: DC md040700) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 371320-1205) |
| 208600000X Surgery (Licence: PA MT189248) | |
| 208600000X Surgery (Licence: PA md437343) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2021-04-22 |