| NPI | 1104051101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID 3371143) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND LT13365) |
| 208600000X Surgery (Licence: ND 13365) | |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2025-03-27 |