| NPI | 1861538951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MS 06635) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN MD0000007792) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2021-01-28 |