| NPI | 1417448507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301115278) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2024032663) |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2024-09-18 |