| NPI | 1396909156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MS 22711) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME109975) |
| 208600000X Surgery (Licence: CA A123894) | |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2020-06-12 |