| NPI | 1144412263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA 0S014229) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OT011695) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2025-03-19 |