| NPI | 1942562608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME166414) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 182527) |
| 208600000X Surgery (Licence: KY TP788) | |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2025-04-24 |