| NPI | 1063897379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 84672) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL OS18036) |
| 208600000X Surgery (Licence: MO 2016036475) | |
| 208600000X Surgery (Licence: SC DO83399) | |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2022-05-05 |