| NPI | 1033117783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL OS 13067) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101013629) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2021-03-25 |