| NPI | 1871808428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD446473) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT197510) |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2018-07-17 |