| NPI | 1215925367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME35997) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME35997) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2020-09-24 |