| NPI | 1932426616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X (Licence: PA OS023728) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MB0944570) |
| 2086S0129X (Licence: NJ 25MB0944570) | |
| 2086S0129X (Licence: VA 0102204594) | |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2024-08-06 |