| NPI | 1366806242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME169386) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 218627) |
| 208600000X Surgery (Licence: VA 0101272137) | |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2025-03-03 |