| NPI | 1760903868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: SD 14495) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 2872) |
| 208600000X Surgery (Licence: MI 5101024539) | |
| 208600000X Surgery (Licence: TX T5338) | |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2024-11-04 |