| NPI | 1952417990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 372807-1205) |
| Additional Taxonomies | 174400000X Specialist (Licence: UT 372807-1205) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2018-10-12 |