| NPI | 1013149707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0102203934) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101016161) |
| Enumeration Date | 2009-08-14 |
| Last Update Date | 2018-09-25 |