| NPI | 1194132084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2022-01244) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 37018) |
| Enumeration Date | 2014-07-13 |
| Last Update Date | 2022-07-26 |