| NPI | 1205848272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 200201117) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 200201117) |
| 208600000X Surgery (Licence: NC 2002-01117) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2024-06-06 |