| NPI | 1285048041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: ID O-1628) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101021200) |
| 208600000X Surgery (Licence: WA OP60938412) | |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2022-03-15 |