| NPI | 1174939441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 64237) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036.148449) |
| 208600000X Surgery (Licence: AZ R74578) | |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2021-09-29 |