| NPI | 1245750231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2022-01473) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL51288) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2023-03-23 |