| NPI | 1932226735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IA DO04544) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR DO166819) |
| 208600000X Surgery (Licence: WA OP60458463) | |
| 208600000X Surgery (Licence: NY 275163) | |
| 208600000X Surgery (Licence: ME DO2427) | |
| 208600000X Surgery (Licence: CT 52913) | |
| 208600000X Surgery (Licence: NH 16503) | |
| 208600000X Surgery (Licence: MN 52743) | |
| 208600000X Surgery (Licence: MI 5101016553) | |
| Enumeration Date | 2007-03-25 |
| Last Update Date | 2020-01-13 |