| NPI | 1043949027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX BP20086310) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10080726) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2023-08-28 |