| NPI | 1023146289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2008-01232) |
| Additional Taxonomies | 208600000X Surgery (Licence: MS 20533) |
| 208600000X Surgery (Licence: SC 35200) | |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2021-05-06 |