| NPI | 1164742748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2015-00195) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL32641) |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2020-10-25 |