| NPI | 1063464683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 64861) |
| Additional Taxonomies | 208600000X Surgery (Licence: SD 3813) |
| 208600000X Surgery (Licence: IA 38654) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2019-02-22 |