| NPI | 1154705200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AR E-15257) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE TEP7573) |
| 208600000X Surgery (Licence: RI MD17112) | |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2022-04-29 |