| NPI | 1588815823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AL MD.31927) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY R1742) |
| 208600000X Surgery (Licence: MD D71551) | |
| 208600000X Surgery (Licence: AL 31927) | |
| Enumeration Date | 2008-10-06 |
| Last Update Date | 2024-02-01 |