| NPI | 1184696502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: LA MD026368) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD425935) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2024-09-03 |