| NPI | 1073806683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2016-01362) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN15966) |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2021-12-16 |