| NPI | 1760687727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101257057) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 30058) |
| 208600000X Surgery (Licence: TX P3266) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2021-03-26 |