| NPI | 1871740787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WY 9151A) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD28789) |
| 208600000X Surgery (Licence: CO 48188) | |
| 208600000X Surgery (Licence: ME MD19116) | |
| 208600000X Surgery (Licence: NM MD2012-0832) | |
| 208600000X Surgery (Licence: WA MD60271016) | |
| 208600000X Surgery (Licence: GU M-1787) | |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2023-07-26 |