| NPI | 1548606619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL OS15155) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101020353) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2018-08-07 |