| NPI | 1134462153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 60481) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA ML60370411) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2021-01-27 |