| NPI | 1225052673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC NC2011-01543) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 35448) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2021-03-19 |