| NPI | 1154536142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101255472) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0116024623) |
| 208600000X Surgery (Licence: OR LL16482) | |
| 208600000X Surgery (Licence: NC 2018-02217) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2023-07-24 |