| NPI | 1164564837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO 1164564837) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101252439) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2024-05-16 |