| NPI | 1245493840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID O-0712) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101017665) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2022-07-21 |