| NPI | 1629128947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: DC 390200000X) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101244571) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2023-01-31 |