| NPI | 1063862712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IA MD-48193) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA R-10624) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2021-07-07 |