| NPI | 1629210869 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2012-0347) | 
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036.121894) | 
| Enumeration Date | 2009-04-02 | 
| Last Update Date | 2024-12-30 |