| NPI | 1245723865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2024027886) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 94-09564) |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2024-11-15 |