| NPI | 1619350469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: SD 12082) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND RL13765) |
| 208600000X Surgery (Licence: CO TL.0006386) | |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2023-10-24 |