| NPI | 1598021834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60755257) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA10409000) |
| 208600000X Surgery (Licence: NY 277748) | |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2021-12-17 |