| NPI | 1366736159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AL MD.49740) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2016-01821) |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2024-11-06 |