| NPI | 1952841892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WA OP61300027) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101023269) |
| Enumeration Date | 2017-02-25 |
| Last Update Date | 2023-04-05 |