| NPI | 1336522820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0065455) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101021893) |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2022-01-10 |