| NPI | 1497243497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2023-00584) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R76654) |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2024-07-30 |