| NPI | 1760619753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0061646) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101017887) |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2019-03-06 |