| NPI | 1073763751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101262786) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301090511) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2022-07-21 |