| NPI | 1730383779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA OS017980) |
| Additional Taxonomies | 208600000X Surgery (Licence: DE c2-0010031) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2023-01-12 |