| NPI | 1588027320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101271904) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10055742) |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2024-05-06 |