| NPI | 1083930275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 67333) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D0077538) |
| 208600000X Surgery (Licence: OR MD202987) | |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2023-05-01 |