| NPI | 1215317128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD474255) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO TL0006296) |
| 208600000X Surgery (Licence: CO DR0061911) | |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2021-06-29 |