| NPI | 1922212729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CO 51485) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO 0051485) |
| 208600000X Surgery (Licence: AL 27181) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2021-03-12 |