| NPI | 1235100678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 33729) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 17825) |
| 208600000X Surgery (Licence: AL 29586) | |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2020-07-27 |