| NPI | 1184014094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 6041) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 283874) |
| 208600000X Surgery (Licence: FL ME154460) | |
| Enumeration Date | 2015-01-30 |
| Last Update Date | 2024-09-24 |