| NPI | 1366854978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NV DO2542) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5151012921) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2021-01-25 |