| NPI | 1134416290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: DC MD46932) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101268931) |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2023-12-28 |