| NPI | 1942278791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101271318) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 21422) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2021-02-22 |