| NPI | 1013312826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME168865) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2016-01671) |
| 208600000X Surgery (Licence: NY 277045) | |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2024-11-21 |