| NPI | 1114982618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CO CDR.0004169) |
| Additional Taxonomies | 202K00000X (Licence: CO CDR.0004169) |
| 208600000X Surgery (Licence: AZ 27566) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2025-02-15 |