| NPI | 1083688972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NH 19396) |
| Additional Taxonomies | 208600000X Surgery (Licence: ME MD22342) |
| 208600000X Surgery (Licence: NC 2010-00021) | |
| 208600000X Surgery (Licence: VA 0101222153) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2022-06-16 |