| NPI | 1013134550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M-11722) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 9679367-1205) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2021-09-14 |