| NPI | 1922155100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NM 85-272) |
| Additional Taxonomies | 174400000X Specialist (Licence: NM 85-272) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2018-12-26 |