| NPI | 1043481336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0102202370) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OS014225) |
| Enumeration Date | 2008-03-14 |
| Last Update Date | 2020-10-28 |