| NPI | 1083624365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AR E5311) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101255594) |
| 208600000X Surgery (Licence: TN 40441) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2024-06-07 |