| NPI | 1366897399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CO TL.0005906) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID O-1983) |
| Enumeration Date | 2016-04-27 |
| Last Update Date | 2024-05-21 |