| NPI | 1780025114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA C197078) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 70733) |
| 208600000X Surgery (Licence: MS 31736) | |
| 208600000X Surgery (Licence: TX 7444063) | |
| Enumeration Date | 2013-07-15 |
| Last Update Date | 2025-01-17 |