| NPI | 1225074313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2012-00716) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD d61917) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2023-12-29 |