| NPI | 1740416239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101257962) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME118535) |
| 208600000X Surgery (Licence: GA 67077) | |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2017-10-23 |