| NPI | 1033112461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AR E-11201) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2012034742) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2020-12-02 |