| NPI | 1164744199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL OS15228) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2010003178) |
| Enumeration Date | 2010-02-18 |
| Last Update Date | 2023-02-24 |