| NPI | 1831540608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: LA 342862) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2016020253) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2024-08-02 |