| NPI | 1801234232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NV 22466) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101257887) |
| Enumeration Date | 2013-06-07 |
| Last Update Date | 2024-07-31 |