| NPI | 1730679416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD224779) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 70904) |
| 208600000X Surgery (Licence: MA 290156) | |
| Enumeration Date | 2018-05-17 |
| Last Update Date | 2025-11-03 |