| NPI | 1639527625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 68214-20) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 6168-851) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2023-05-18 |