| NPI | 1861508954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD031995E) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PA AK000232L) |
| 208600000X Surgery (Licence: NJ 25MA04461600) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2016-02-25 |