| NPI | 1164528717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO 35108) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 7656872-1205) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2021-09-27 |