| NPI | 1174757652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301503086) |
| Additional Taxonomies | 204F00000X Transplant Surgery (Licence: WV 33019) |
| 208600000X Surgery (Licence: NV 18736) | |
| 204F00000X Transplant Surgery (Licence: NV 18736) | |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2024-05-14 |