| NPI | 1407292758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME160773) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A156471) |
| 208600000X Surgery (Licence: IL 036155057) | |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2024-07-01 |