| NPI | 1649562687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2014-00528) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD185958) |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2019-07-14 |