| NPI | 1962673152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX Q0302) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD30947) |
| 208600000X Surgery (Licence: IL 036.131608) | |
| 208600000X Surgery (Licence: PA MT190531) | |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2022-09-02 |