| NPI | 1689998049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NH 16056) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD432197) |
| 208600000X Surgery (Licence: NY 264953) | |
| Enumeration Date | 2010-03-15 |
| Last Update Date | 2021-04-12 |