| NPI | 1245618297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL OS16577) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD H0090453) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2024-06-17 |