| NPI | 1053756221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 65762) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101020298) |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2020-09-18 |