| NPI | 1538307236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MT 116929) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101017851) |
| Enumeration Date | 2009-02-03 |
| Last Update Date | 2022-11-11 |