| NPI | 1114100559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AL MD31787) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC AN3187956-S48) |
| 208600000X Surgery (Licence: KY 43830) | |
| Enumeration Date | 2007-12-07 |
| Last Update Date | 2020-05-28 |