| NPI | 1043283336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WY 9756A) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID M-9325) |
| 208600000X Surgery (Licence: MT 12855) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2023-11-02 |