| NPI | 1760574776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 6655906-1205) |
| Additional Taxonomies | 174400000X Specialist (Licence: NV 10997) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2022-01-10 |