| NPI | 1295885309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 23688) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 61892) |
| 208600000X Surgery (Licence: GA 074380) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2021-10-19 |