| NPI | 1285084087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AL 42610) |
| Additional Taxonomies | 208600000X Surgery (Licence: MS T-3534) |
| 208600000X Surgery (Licence: MO 2016012955) | |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2023-01-16 |