| NPI | 1427041391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35063328) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 75803) |
| 208600000X Surgery (Licence: NC 200100450) | |
| 208600000X Surgery (Licence: IN 01069217A) | |
| 208600000X Surgery (Licence: MN 69056) | |
| 208600000X Surgery (Licence: LA 329793) | |
| 208600000X Surgery (Licence: CO CDR.0001308) | |
| 208600000X Surgery (Licence: GA 97280) | |
| 208600000X Surgery (Licence: MT 98666) | |
| 208600000X Surgery (Licence: WA 61205651) | |
| 208600000X Surgery (Licence: NH 20416) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2025-09-15 |