| NPI | 1053388637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.121334) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 36446) |
| 208600000X Surgery (Licence: CA A88984) | |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2021-03-18 |