| NPI | 1467728014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0069126) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX 648430) |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2022-08-01 |