| NPI | 1467655050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NV 15395) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101241916) |
| 208600000X Surgery (Licence: UT 11473505-1205) | |
| Enumeration Date | 2007-06-09 |
| Last Update Date | 2025-12-17 |