| NPI | 1669631651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60125808) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 244617) |
| Enumeration Date | 2008-06-04 |
| Last Update Date | 2024-10-04 |