| NPI | 1104945864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC LL 27894) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2012-01261) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2021-08-25 |