| NPI | 1376983627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 74449) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301103576) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2021-11-22 |