| NPI | 1205276052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 84067) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301103691) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2020-11-04 |