| NPI | 1578719217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101253937) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD P23574) |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2020-12-29 |