| NPI | 1821095662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD048642L) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ MA61113) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2021-07-21 |