| NPI | 1043411259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2021-02421) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OS012891) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2021-11-02 |