| NPI | 1003042409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2011-01276) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT AS2383278-0706) |
| Enumeration Date | 2009-06-01 |
| Last Update Date | 2023-08-29 |