| NPI | 1225526809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2023-01794) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX 677827) |
| Enumeration Date | 2018-04-28 |
| Last Update Date | 2023-09-12 |