| NPI | 1225470594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA OS018895) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OT014858) |
| Enumeration Date | 2013-07-26 |
| Last Update Date | 2022-07-21 |