| NPI | 1578500336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 20A16824) |
| Additional Taxonomies | 208600000X Surgery (Licence: NV 1229) |
| 208600000X Surgery (Licence: UT 10507734-1204) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2025-03-17 |