| NPI | 1104110063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0068267) |
| Additional Taxonomies | 208600000X Surgery (Licence: HI MD-17076) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2022-06-02 |