| NPI | 1033452644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0087266) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101271216) |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2021-06-10 |