| NPI | 1104234707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 52652) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY R3515) |
| 208600000X Surgery (Licence: TN 63346) | |
| Enumeration Date | 2014-07-27 |
| Last Update Date | 2024-07-22 |