| NPI | 1184878555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: KY IP 1111) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2015010387) |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2024-10-14 |