| NPI | 1205041571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 45679) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A108305) |
| 208600000X Surgery (Licence: FL ME112102) | |
| 208600000X Surgery (Licence: WV 24783) | |
| 208600000X Surgery (Licence: PA md437802) | |
| 208600000X Surgery (Licence: PA mt196167) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2019-10-25 |