| NPI | 1063404572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35056109) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ AZ20804) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2024-03-13 |