| NPI | 1033184817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 32528) |
| Additional Taxonomies | 208600000X Surgery (Licence: NM MD2004-0342) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2020-11-06 |