| NPI | 1235513383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA OS018580) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL OS16857) |
| 208600000X Surgery (Licence: PA OT016318) | |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2023-09-25 |