| NPI | 1023054640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX Q7265) |
| Additional Taxonomies | 174400000X Specialist (Licence: MT 7736) |
| 174400000X Specialist (Licence: TX Q7265) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2022-06-21 |