| NPI | 1124313556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 86092) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL 36866) |
| 208600000X Surgery (Licence: TN 56149) | |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2022-07-21 |