| NPI | 1992888341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD039872L) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP 026069 L) |
| 183500000X Pharmacist (Licence: PA RP026069L) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: PA XD039872L) | |
| 208600000X Surgery (Licence: PA MD 039872 L) | |
| Enumeration Date | 2006-10-21 |
| Last Update Date | 2019-05-23 |