| NPI | 1538160908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME129562) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301049444) |
| 208D00000X General Practice (Licence: MI 4301049444) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2018-03-17 |