| NPI | 1245806025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: ND RL18721) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10074490) |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2022-06-21 |