| NPI | 1073577375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 84100) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 200901168) |
| 208600000X Surgery (Licence: VA 0101052466) | |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2021-08-25 |