| NPI | 1104055185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 53835) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA R-8752) |
| 208600000X Surgery (Licence: NY 285906) | |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2022-09-09 |