| NPI | 1285921171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 075622) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301099137) |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2020-07-30 |