| NPI | 1093236036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA pending) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 66051) |
| 208600000X Surgery (Licence: MN 28632) | |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2023-12-21 |