| NPI | 1194761924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301067751) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI AG067751) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2020-01-13 |