| NPI | 1245525989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 70849-20) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 7365) |
| 208600000X Surgery (Licence: MI 4301098449) | |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2024-01-16 |