| NPI | 1154859643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 58111) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301506733) |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2023-12-21 |