| NPI | 1205095585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX P6795) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101017604) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2022-04-19 |