| NPI | 1245463157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 55430) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301092859) |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2020-03-11 |