| NPI | 1871521294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M16438) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX G8424) |
| 208600000X Surgery (Licence: WA MD60252644) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2024-05-08 |