| NPI | 1780976480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 006665) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101018971) |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2022-11-02 |