| NPI | 1902974850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301089271) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 68950-20) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2022-07-26 |