| NPI | 1164912507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID O-2014) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101023796) |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2024-06-20 |