| NPI | 1235142357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101248712) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2015-00091) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2024-04-30 |