| NPI | 1992147912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA OS017923) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OT015033) |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2022-05-31 |