| NPI | 1891137485 |
|---|---|
| Other Name | NOT APPLICABLE NOT APPLICABLE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 29019) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101267383) |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2022-03-16 |