| NPI | 1992819619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X (Licence: VA 0101049993) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101049993) |
| 2086S0129X (Licence: VA 010104993) | |
| 174400000X Specialist (Licence: VA 0101049993) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2024-03-08 |