| NPI | 1316350085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A158371) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 94-08305) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2019-02-06 |