| NPI | 1700034766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD444229) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT 189899) |
| 208600000X Surgery (Licence: DE C1-0011143) | |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2020-08-21 |