| NPI | 1750331757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M-9041) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 0424797) |
| 208600000X Surgery (Licence: CO DR-33966) | |
| 208600000X Surgery (Licence: MO 119790) | |
| 208600000X Surgery (Licence: MT 11652) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2021-11-11 |