| NPI | 1720246358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0076378) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101255407) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2022-06-21 |