| NPI | 1871660597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AR E11511) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101102667) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2020-10-15 |