| NPI | 1609030675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0075837) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT193756) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2018-04-17 |