| NPI | 1033365978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME113148) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125053169) |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2021-12-09 |