| NPI | 1366858086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 9800988) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 98-00988) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2024-02-23 |