| NPI | 1619281292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101254500) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0116022789) |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2025-02-25 |