| NPI | 1457367302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 0000055171) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301060968) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2023-12-12 |