| NPI | 1629289186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 20A 10739) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101016113) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2020-02-03 |