| NPI | 1033344866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 201500744) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2015-00744) |
| Enumeration Date | 2009-05-22 |
| Last Update Date | 2021-03-19 |