| NPI | 1376868281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 1924-320) |
| Additional Taxonomies | 208600000X Surgery (Licence: GU M-1942) |
| 208600000X Surgery (Licence: PA MD456117) | |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2022-09-23 |