| NPI | 1255511572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AL 32228) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2012-00248) |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2023-01-05 |