| NPI | 1831118041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AL 27329) |
| Additional Taxonomies | 174400000X Specialist (Licence: AL 00027329) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2024-06-19 |