| NPI | 1548592272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0102209063) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 4951) |
| 208600000X Surgery (Licence: PA OS021057) | |
| Enumeration Date | 2010-02-05 |
| Last Update Date | 2025-02-18 |