| NPI | 1730599366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.143165) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10049567) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2025-08-18 |