| NPI | 1508919572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MN TP 106852) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD T1619) |
| Enumeration Date | 2007-01-20 |
| Last Update Date | 2022-04-04 |