| NPI | 1174677124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 054016) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME96681) |
| 208600000X Surgery (Licence: MS 21373) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2021-11-17 |