| NPI | 1174019582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A160490) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301509632) |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2024-09-10 |