| NPI | 1063662179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 55538) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME166998) |
| 208600000X Surgery (Licence: IL 125051548) | |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2024-06-11 |