| NPI | 1164816013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301107142) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: MI 4301107142) |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2024-11-22 |