| NPI | 1225425101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA MD-49534) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2020017648) |
| Enumeration Date | 2015-04-18 |
| Last Update Date | 2022-04-14 |