| NPI | 1225324395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OR DO176949) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR PG155161) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2020-11-11 |