| NPI | 1295963122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL OS17351) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101018119) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2022-02-14 |