| NPI | 1942292503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101223708) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2020-03144) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2021-09-08 |