| NPI | 1134322571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 51874) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2023025609) |
| 208600000X Surgery (Licence: MD H72718) | |
| 208600000X Surgery (Licence: MD H0072718) | |
| 208600000X Surgery (Licence: WV 2839) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2024-01-11 |