| NPI | 1336349125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME110448) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO DR.0074114) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2024-12-10 |