| NPI | 1376596023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 81717) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 4391) |
| 208600000X Surgery (Licence: SD 10172) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2025-03-07 |