| NPI | 1639436314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35140113) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT201039) |
| 208600000X Surgery (Licence: IN 01080017A) | |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2020-07-31 |