| NPI | 1114593761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MT225045) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC MMD.86246LL) |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2023-10-18 |