| NPI | 1194907592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M-10728) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 5761523-1205) |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2020-10-02 |