| NPI | 1023561263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 57233) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R76451) |
| 208600000X Surgery (Licence: FL ME151261) | |
| Enumeration Date | 2016-07-23 |
| Last Update Date | 2022-09-20 |