| NPI | 1497926323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 88865) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 025774) |
| 208600000X Surgery (Licence: FL ME134536) | |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2024-03-15 |