| NPI | 1891923710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX P6618) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP2-0035882) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2024-02-06 |