| NPI | 1013402874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4351045078) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R77048) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2019-06-13 |