| NPI | 1164957098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 208600000x) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 191356) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2024-02-08 |