| NPI | 1497209548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX T7743) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN25581) |
| 208600000X Surgery (Licence: MO 2016022430) | |
| Enumeration Date | 2016-08-06 |
| Last Update Date | 2022-10-14 |