| NPI | 1922242809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: HI MD18563) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD432824) |
| 208600000X Surgery (Licence: KY 44300) | |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2016-08-10 |