| NPI | 1164403937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AL 25351) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036136916) |
| 208600000X Surgery (Licence: AL 00025351) | |
| 208600000X Surgery (Licence: WI 62414) | |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2023-11-07 |