| NPI | 1104233071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 008450) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101024452) |
| Enumeration Date | 2014-07-12 |
| Last Update Date | 2023-09-22 |