| NPI | 1356544282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME112612) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN11572) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2019-04-17 |