| NPI | 1477896025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME156749) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX S4392) |
| 208600000X Surgery (Licence: CA A135312) | |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2022-10-26 |