| NPI | 1336474535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AR E-9419) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL OS12386) |
| 208600000X Surgery (Licence: OH 34.010551) | |
| Enumeration Date | 2009-10-06 |
| Last Update Date | 2020-09-15 |