| NPI | 1801003124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2013012267) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 34.013102) |
| 208600000X Surgery (Licence: IN 02003822A) | |
| 208600000X Surgery (Licence: MI 5101015419) | |
| 208600000X Surgery (Licence: FL OS 11844) | |
| 208600000X Surgery (Licence: SC 849) | |
| 208600000X Surgery (Licence: WA OP61671762) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2025-07-30 |