| NPI | 1053441014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA 0S014631) |
| Additional Taxonomies | 208600000X Surgery (Licence: DE C7-0002470) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2022-10-13 |