| NPI | 1982864856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0069954) |
| Additional Taxonomies | 208600000X Surgery (Licence: AK 115925) |
| 208600000X Surgery (Licence: NE 25534) | |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2022-12-20 |