| NPI | 1053315879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA MD-46820) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 67223) |
| 208600000X Surgery (Licence: WI 72644) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2024-04-09 |