| NPI | 1275820987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2016-00425) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101019585) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2023-06-09 |