| NPI | 1174780605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2023-00071) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 51805) |
| 208600000X Surgery (Licence: AR E-9440) | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2024-01-19 |