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 |