| NPI | 1932634607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 5101026883) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101022993) |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2025-03-20 |