| NPI | 1780878595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A114371) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD432350) |
| 208600000X Surgery (Licence: NY 263868) | |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2012-05-18 |