| NPI | 1508108945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 008056) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC DO034734) |
| 208600000X Surgery (Licence: KS 05-42508) | |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2023-12-06 |