| NPI | 1750669024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME143987) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 24557) |
| 208600000X Surgery (Licence: WY 13199A) | |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2023-08-09 |