| NPI | 1093339632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101285120) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL84192) |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2025-06-18 |