| NPI | 1144234881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME98890) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 200600755) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2022-03-08 |