| NPI | 1083775803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 077727) |
| Additional Taxonomies | 208600000X Surgery (Licence: ME MD19112) |
| 208600000X Surgery (Licence: AL MD.26147) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2022-07-21 |