| NPI | 1710338645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 76356-21) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101022650) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2021-12-09 |