| NPI | 1689877821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 82086) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101017071) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2021-07-14 |