| NPI | 1104079326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301113503) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 31127) |
| Enumeration Date | 2008-10-31 |
| Last Update Date | 2021-03-29 |