| NPI | 1508062894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MT 91827) |
| Additional Taxonomies | 208600000X Surgery (Licence: ME MD22427) |
| 208600000X Surgery (Licence: CO TL2492) | |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2024-02-19 |