| NPI | 1023089109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2007-00980) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 23188) |
| 208600000X Surgery (Licence: SC 20321) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2022-01-14 |