| NPI | 1912385378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X (Licence: WI 77231) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101021748) |
| 2086S0129X (Licence: OK 6906) | |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2025-08-07 |