| NPI | 1528321809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301111192) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R73297) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2022-07-21 |