| NPI | 1801043013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AK 7534) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2008003314) |
| 208600000X Surgery (Licence: CO 46118) | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2017-06-28 |