| NPI | 1225004187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WY 6423A) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO 26688) |
| 208600000X Surgery (Licence: NE 16963) | |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2023-02-09 |