| NPI | 1689815227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AR E7408) |
| Additional Taxonomies | 208600000X Surgery (Licence: AR E-7408) |
| 282NC0060X General Acute Care Hospital, Critical Access (Licence: LA 627) | |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2021-10-25 |